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Form preview Form 5000 en Internet - DGI 5000-EN For use by the foreign tax authority CERTIFICATE OF RESIDENCE 1281601 Application for implementation of the tax treaty between France and Number of attachments Please write the name of the country in this box I Types of income Normal procedure Attach Form 5001 Interest Simplified procedure Dividends File this certificate of residence only Royalties II Beneficiary Surname and first name or company name. Occupation Full home address or registered office For United States residents See note Investment companies and funds please complete box VII as well I hereby declare that - I am beneficially entitled to the income for which the treaty benefits are being claimed - For the purposes of the abovementioned tax treaty the beneficiary is a resident of or in the case of pension fund or an investment company is established in. - I do not have any establishment or permanent base that this income is attached to in France - This income has been or will be reported to the tax authorities in my country of residence. Date and place Signature of beneficiary or his/her legal representative IV Declaration of the foreign tax authority The tax authority of. - The information provided by the applicant is correct hereby certifies that to the best of its knowledge - The beneficiary of the income is subject to taxation by the authority under the tax identification number. where applicable. Signature and seal Name Address SIREN number the rate provided for in French domestic law. Seal For beneficiaries who are United States residents only The abovenamed institution hereby certifies that to the best of its knowledge the applicant is a resident of the United States and that the information provided on this form is correct. VII Investment company or fund Financial year from. to In the case of German funds if the French authorities - have issued an authorisation authorisation date and number authorisation number date. Number of unit holders or shareholders in fund Percentage of unit holders or shareholders who are residents of. VIII In case of direct refund by the tax authority Where should the repayment be sent bank post office account To be kept by French tax ATTESTATION DE RESIDENCE Demande d application de la convention fiscale entre la France et Nombre d annexes Inscrire dans cette case le nom de l Etat contractant I Nature des revenus Proc dure normale Proc dure simplifi e Joindre un formulaire annexe n 5001 Int r ts Redevances II D signation du b n ficiaire des revenus Nom et pr nom ou raison sociale Profession Adresse compl te du domicile ou du si ge social Pour les r sidents des Etats-Unis cf* notice III D claration du b n ficiaire des revenus Fonds et soci t s d investissement compl ter aussi le cadre VII Le soussign certifie - tre le b n ficiaire effectif des revenus pour lesquels le b n fice de la convention est demand - avoir au sens de la convention fiscale susvis e la qualit de r sident de ou s agissant d un fonds de pension ou d un fonds ou d une soci t d investissement tre tabli.
Form preview Uniform sales use tax exemptio... UNIFORM SALES USE TAX EXEMPTION/RESALE CERTIFICATE MULTIJURISDICTION The below-listed states have indicated that this certificate is acceptable as a resale/exemption certificate for sales and use tax subject to the notes on pages 2 4. A This certificate is not valid as an exemption certificate. Its use is limited to use as a resale certificate subject to the provisions of Title 18 California Code of Regulations Section 1668 Sales and Use Tax Regulation 1668 Resale Certificate. Pennsylvania This certificate is not valid as an exemption certificate. It is valid as a resale certificate only if it contains the purchaser s Pennsylvania Sales and Use Tax eight-digit license number subject to the provisions of 61 PA Code 32. Florida Allows the Multistate Tax Commission s Uniform Sales and Use Tax Exemption/Resale Certificate Multijurisdictional for tax-exempt purchases for resale however the selling dealer must also obtain a resale authorization number from the Florida Department of Revenue at floridarevenue. You should check with the relevant state to determine whether you meet the requirements of that A Buyer who is a reseller of tangible property or taxable services from a Seller located in one of the states listed may be able to use this certificate for sales tax exemption. States vary in their policies for use of this revenue department of the relevant state. Wisconsin Wisconsin allows this certificate to be used to claim a resale exemption only. It does not permit this certificate to be used to claim any other type of exemption. Frequently Asked Questions Uniform Sales and Use Tax Certificate Multijurisdictional To whom do I give this certificate Can I register for multiple states simultaneously I have received this certificate from my customer. Of Taxation Tax Information Release No. 93-5 November 10 1993 and Tax Information Release No. 98-8 October 30 1998. Illinois Use of this certificate in Illinois is subject to the provisions of 86 Ill. Adm. Code Ch.I Sec. 130. 1405. Illinois does not have an exemption for sales of property for subsequent lease or rental nor does the use of this certificate for claiming resale purchases of services have any application in Illinois. B Even if property is delivered outside Missouri facts and circumstances may subject it to Missouri tax contrary to the second sentence of the first paragraph of the above instructions. b the buyer is not required to be registered in New Mexico and c the buyer is purchasing tangible personal property for resale or incorporation as an ingredient or component of North Carolina This certificate is not valid as an exemption certificate if signed by a person such as a contractor who intends to use the property. The issuer and the recipient have the responsibility to determine the proper use of this certificate under applicable laws in each state as these may change from time to time. Issued to Seller Address I certify that Name of Firm Buyer is engaged as a registered Wholesaler Retailer Manufacturer Seller California Lessor see notes on pages 2 4 Other Specify and is registered with the below-listed states and cities within which your firm would deliver purchases to us and that any such purchases are for wholesale resale or ingredients or components of a new product or service to be resold leased or rented in the normal course of business.

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